24例复杂性肾血管平滑肌脂肪瘤诊治临床分析

目的:探讨包括体积≥7 cm的大体积、易误诊为肾恶性肿瘤的及多发病灶的肾血管平滑肌脂肪瘤患者影像诊断、综合治疗原则。方法:回顾性分析扬州大学附属医院、南京市鼓楼医院、江苏省人民医院收治的24例复杂性肾血管平滑肌脂肪瘤患者围手术期的临床资料。结果:大体积肾血管平滑肌脂肪瘤患者共15例，其中2例患者行超选择性肾动脉分支栓塞术，6例行机器人辅助腹腔镜下肾部分切除术，3例行开放肾切除术，4例行超选择性肾动脉分支栓塞术加腹腔镜下肾部分切除术；误诊为肾细胞癌的肾血管平滑肌脂肪瘤患者4例均行机器人辅助腹腔镜下肾部分切除术；多发病灶的肾血管平滑肌脂肪瘤患者5例，其中3例行超选择性肾动脉分支栓塞术，2例行机器人辅助腹腔镜下肾部分切除术。接受手术治疗患者均顺利完成，无术中死亡患者。其中1例患者行肾部分切除后出现出血，后行肾切除术。所有患者术后定期复查，均未出现局部复发、迟发性出血及远处转移。结论:复杂性肾血管平滑肌脂肪瘤患者术前影像学评估方面需通过CT、MRI或者纹理分析等更为先进的方法充分评价，大体积或多发肾血管平滑肌脂肪瘤可通过微创手术治疗，这是一种安全、有效的方式，对于高危患者可通过多种不同方式减少术中出血、缩短热缺血时间，最大限度保护肾功能。

Clinical experience about management of complex renal angiomyolipoma:24 cases

Objective:To discuss the imaging diagnosis and treatment principles of patients with renal angiomyolipoma,which consist of easily misdiagnosed as malignant renal tumors and multiple lesions,with a volume of more than 7 cm.Methods:The perioperative clinical data of 24 patients with complex renal angiomyolipoma from the Affiliated Hospital of Yangzhou University,Drum Tower Hospital of Nanjing and People's Hospital of Jiangsu Province were retrospectively analyzed.Results:There were 15 cases of large volume renal angiomyolipoma,in which,2 cases underwent superselective renal artery branch embolization,6 cases underwent robot-assisted laparoscopic partial nephrectomy,3 cases underwent open nephrectomy,4 cases underwent superselective renal artery branch embolization plus laparoscopic partial nephrectomy.Robot-assisted laparoscopic partial nephrectomy was performed in all 4 cases which were misdiagnosed as renal cell carcinoma.There were 5 patients with multiple renal angiomyolipomas,in which,3 cases underwent superselective renal artery branch embolization and 2 cases underwent robot-assisted laparoscopic partial nephrectomy.No intraoperative death occurred.One patient had hemorrhage after partial nephrectomy and then underwent nephrectomy.No local recurrence,delayed hemorrhage and distant metastasis were found in all patients after regular follow-up.Conclusion:The preoperative imaging evaluation of patients with complex renal angiomyolipoma needs to be fully evaluated by more advanced methods such as CT,MRI even texture analysis.Large or multiple renal angiomyolipoma can be treated by minimally invasive surgery,which is a feasible and effective method.For high-risk patients,intraoperative bleeding can be reduced in many different ways in order to shorten the time of warm ischemia and maximize the protection of renal function.